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This Valentine's Day
give her the "You Grew In My Heart" Pendant.
She'll love this fine custom-crafted sterling silver pendant. Use the heart-shaped surface on the back to engrave a birth date or other special message. Also available as a slightly smaller charm. Shop now.

Midwifery Today Conferences

Learn the benefits of waterbirth!

Attend the full-day class with Barbara Harper and discover the unique psychological and physical properties of water that make it so beneficial to birthing women. You'll learn that breech births, OP births and twin births can all benefit from waterbirth. Barbara will also discerns the concerns about and potential risks of water labor and waterbirth. She will report on clinical findings, current research and models from various places around the world, as well as share her hands-on experience. Part of our March 2007 conference in Eugene, Oregon. Go here for info.

Do you want to be a doula?

Join DONA International Doula Educator Debra Pascali-Bonaro for a three-day Doula Workshop at our May 2007 conference in Costa Rica. You'll learn the history, research and doula skills that enhance labor and birth while decreasing many medical interventions. Attend all three days and you'll have taken one step in the certification process for DONA International. Go here for more information and a complete program.

Quote of the Week

— Lisa King
Guadalajara, Mexico
(Thanks to Joni Nichols for sharing this with us)

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The Art of Midwifery

Did you know that morning sickness killed Charlotte Bronte? Complications from dehydration caused the death of the pregnant author of Jane Eyre. Nearly 90 percent of pregnant women experience hyperemesis gravidarum to some extent during the first trimester. Almost every woman who has experienced pregnancy has her own stories of upset stomach, nausea and strange aversions to certain foods or aromas.

As recent clinical studies focused on ginger root have shown, the old remedy long used for upset stomach and nausea now has the backing of scientific research to validate its anti-emetic qualities. No teratogenicity or neonatal toxicity were reported in any of these clinical studies.

To learn more about how to use ginger for nausea and vomiting in pregnancy, order The Birthkit Issue 36

ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.

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Hyperemesis Gravidarum

NVP (Nausea and vomiting during pregnancy) affects about 70-80 percent of pregnant women. Some reports range from 50-90 percent, but most are in the 70-80 percent range. In 20 percent of NVP cases, these symptoms persist throughout pregnancy.

[Hyperemesis gravidarum (HG) is defined as] "severe vomiting in early pregnancy that causes 5% weight loss and ketonuria... usually associated with increased hCG concentration." The vomiting is typically intractable and leads to evidence of disturbed nutrition, altered electrolyte balance or dehydration. Incidence of hyperemesis gravidarum (HG) seems to be about 0.8 percent or 0.9 percent, though estimates vary from 0.3 percent to 2 percent.

HG has been linked to a variety of symptoms including dehydration, ketosis, ptyalism (excessive salivation), high thyroxine, low pyridoxine, high serum transaminase, hyperthyroidism, hyperparathyroidism, altered lipid metabolism, liver dysfunction, rising pulse rate, falling blood pressure, dry and furry tongue, loss of skin elasticity, chronic hypovolemia, and jaundice. Symptoms typically occur during the first trimester of pregnancy, usually beginning between the fourth and tenth weeks of gestation, peaking between the eighth and twelfth weeks, and resolving by the twentieth week.

While the relation between most psychological factors and HG appears to be unfounded, there is some case-study evidence suggesting that dietary behavior may play a role. A risk factor for HG seems to be an "unsuitable diet, with large and infrequent meals."

[T]reatments involving correction of fluid and electrolyte deficiencies appear to be safe and highly effective; patients receiving such treatment have an excellent prognosis with no significant increased risk of fetal loss or major complications.

The Birthkit Issue 26 includes a summary of data about HG, natural remedies, a midwife's response to the issue of HG and an HG sufferer's commentary. The BirthkitIssue 26

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SPECIAL OFFER TO E-News Readers: Subscribe to Mothering Magazine for only $17.95.

That's $5 off our regular price of $22.95 for a one-year subscription! Mothering magazine is the premier publication of the natural family living community. Every publication addresses contemporary, evidence-based parenting and personal issues in an upbeat, intelligent and compassionate manner. Go here for a discounted subscription, then choose New or Gift orders and enter the code A04MT.

Research to Remember

Hyperemesis gravidarum (HG), or severe vomiting during pregnancy, often requires hospitalization due to fluid volume depletion, metabolic disturbances and weight loss. A retrospective study showed that women who were hospitalized with HG had a higher risk of preeclampsia than those not hospitalized, and more often required extended hospital stays after both vaginal and cesarean births. In addition, babies born to women with HG were more likely to have low birth weights than those who did not have HG.

The University of Cincinnati has launched two new distance learning programs that make it possible for working nursing professionals to earn their Master's degrees in just two years. Coursework is completed online, while clinical experiences are conducted with preceptors in your community. More information here.

Products for Birth Professionals

Give her the The Mother and Child Pin…
…and watch her eyes light up as she opens the package to uncover a delicate sterling silver outline of a mother embracing her child. Designed by Matt Willig, this 1-3/4 inch pin makes a lovely gift for mothers, grandmothers or anyone who nurtures small children.

Learn "About Physiology in Pregnancy and Childbirth"

A compilation of eight articles by Verena Schmid, an independent midwife from Italy, this book will give you a unique view of pregnancy, birth and related processes. Verena applies her nearly 30 years of midwifing homebirths to providing you with a deeper understanding of the complex biological processes that make up the perinatal period. This book is must reading for informed midwives and mothers-to-be.

If you want to be to be a Midwife...

...you need the book. Paths to Becoming a Midwife: Getting an Education has 328 pages packed with useful information that will help you make wise choices. It includes a directory of over 150 schools, programs and other resources.

Discover the deeper, spiritual dimensions of pregnancy and births.

The Roots of Natural Mothering by Janice Marsh-Prelesnik, midwife and mother of four, explores the lifestyle of natural mothering. You'll learn to trust your intuition, how to choose your birth nest, how to stay healthy naturally throughout your pregnancy and much more. If you're pregnant or planning to be, this book will help you make decisions based on what is right for you and your baby. If you're a midwife or other birth professional, it makes a perfect addition to your lending library.

Fill 2007 with Photos of New Life!

Put Harriette Hartigan's 2007 Into Being calendar on your wall and fill your year with heart-warming black and white photos of pregnant moms and newborns. What a lovely gift for your midwife or doula, your pregnant friend or relative, your mother, your grandmother or anyone who loves babies.Click here.

Make sure you get the whole story.

Midwifery Today E-News is only a sample of what you'll find in Midwifery Today magazine. Subscribe and you'll receive a 72-page quarterly print publication filled with in-depth articles, birth stories from around the world, stunning birth photography, news, reviews and more.

Networking

Birth is an intimate event.

It is both personal and universal. It keeps the world going while changing the lives of those who experience it.

A woman who gives birth in a supportive and private environment where she feels safe and protected can relax and let go. In many cases, birth culminates in orgasmic release.

The film Orgasmic Birth shows real births in which precisely that happens. Women in Brazil, England, Mexico, New Zealand and the United States who have experienced ecstasy in birth generously permitted their deliveries to be filmed and shown. They wanted to share the powerful joy that a woman can experience when the birth setting frees her to birth as she was meant to do.

In Orgasmic Birth, interviews with new parents reveal their high level of satisfaction in having their babies in this way. Experts such as Marsden Wagner, Ina May Gaskin, Robbie Davis-Floyd, Elizabeth Davis, Naoli Vinaver, Dr. Christiane Northrup and others, explain what has gone wrong in birth and suggest ways to repair it.

Now in final stages of editing, this pioneering film reminds us of truths about pregnancy, labor, birth, and breastfeeding that the overuse of technology and women's loss of connection with their own bodies have let us forget.

What you can do

Your financial participation will help us use the power of the media to provide positive images and accurate information. We want to show everyone the power and pleasure that can be attained during birth.

To learn more about this pioneering film and how you can help it to reach as many people as possible, please visit: www.orgasmicbirth.com

Advertising Opportunities

Eugene, Oregon, Conference 2007

Join Midwifery Today at our next conference, "Midwifery Leading the Way," to be held in our home town of Eugene, Oregon, March 14–18, 2007. We expect a great turnout, so start planning to be a part of this exciting conference. Whether you exhibit, put an ad in the program or send inserts, you don't want to miss this opportunity!
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"Spring into Savings" Coupon Page

Reach thousands of online shoppers with the "Spring into Savings" Coupon Page available on the Midwifery Today Web site. Advertise online from April–June; includes a hotlink to your own Web site.
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Midwifery Today E-News

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Question of the Week

Q: I need some advice in dealing with/assisting a private client. She is prone to premature births, hyperemisis gravidarum (HEG) and preeclampsia, and has celiac disease (she cannot eat wheat). (I am aware that the preeclampsia is a result of the hyperemesis and malnutrition, and was attempting to help prevent it.) However, I noticed she has a history of eating disorders, and is exercising 1–1/2 to 2 hours a day.

Alarm bells have started to ring in my head as I read about how debilitating HEG can be. If she is that sick now, how can she keep going? She refuses to be hospitalized, although she spends at least one day a week there being tested. I suggested she cut her cardio down to 30 minutes a day (rather than an hour and a half!), and substitute Tai Chi or yoga. Everything the doctors have tried has seemed not to work (including Zofran). When she started forcing herself to eat regularly her vomiting increased from five times a day to 15. I've done quite a bit of research on the disease and ways to help, but apparently nothing I or anyone else has suggested works or helps in the least. Any thoughts or suggestions? I'm stumped with this one. Feel free to e-mail me privately at avhaas@rochester.rr.com.

— Amy Haas

SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.

Question of the Week Responses

Q: Thank you for the recent informative issue on the perineum. This is an incredibly tender subject for me. I had a third degree tear that still haunts me to this day, even though it has long healed and my daughter is now 16 months old. I wonder every day whether it has healed properly. I wonder every day what I did wrong to cause such trauma. Being a woman of young maternal age, and having very few stretch marks and a non-assisted delivery, I don't understand why this happened. I had a postpartum checkup six weeks after the birth and my midwife told me it was healing fine, but nothing has been said since and I constantly wonder. I feel broken. How do I know I healed normally?

I have another upcoming child due mid-February and I'm terrified. I don't know whether or not I don't want to tear, or if I do want to tear again so that maybe it can heal better. Is that even possible? Tearing again to facilitate better healing? What is "healed" and how do I know if I am? It's not like I can go to a Web site and see what "normal" perinea of women who have birthed children look like. Is it normal to be so utterly hung up on a matter like this? Thank you for your time.

— Sarah
Arizona

A: I think that it is VERY normal to be fixated on something that is not yet right for you. I, too, had a debilitating tear with my first baby. My homebirth midwife diagnosed a third degree tear as a first degree tear, insisting that if I kept my legs together all would be well. I did, and it wasn't. An attempt at an office repair (obstetrician) at eight weeks was very painful and unsuccessful; I was told that anything could be fixed if I was willing to go to the OR under anesthesia. Six years and another baby later I am just now finding peace and pleasure with the status of things.

Somewhere there is a sensitive care provider who can lovingly help you assess your perineum. Ask around; you'll be surprised how many women share your injury and worry! I was a senior apprentice midwife at the time and was shocked at how many of our past clients came forward to tell me similar stories! My second homebirth was with a midwife who did a lot of "tissue release" work around my tear and vagina, which helped things feel MUCH better. Reasonance Repatterning (previously Holographic Repatterning, www.holographic.org ) is amazing at releasing energy constrictions (trauma memory in tissue or spirit). I took care the second time to be in any position but supine or even semi-supine to give my perineum the best opportunity to stretch easily—hands and knees felt great! Or waterbirth or side-lying or standing might also work for you.

Read the birth stories in Ina May's Guide to Childbirth. The most useful thing that the second midwife said to me was that she had seen women with scar tissue have the next baby's birth stretch that scar tissue so that there was a "self-healing" quality to the birth, setting things (more) right, and that there can be a "healing stretch." That became my crowning mantra—"This is a healing stretch!"

I've changed many things about how I assess vaginal damage after a birth as a result my own experience. I think that as midwives we sometimes do a disservice to first-time mothers when we reassure them that they are "fine." What is much more important is their own perspective, and we might help more by educating women that having the "landscape" change in some way is pretty common. I find that when I explain that changes are going to occur, that they might LOOK a bit more open, they might see changes, and that they will still have great fun with that part of their body—they have a lot less dismay and fear when they take a look the first time.

I LOVE Midwifery Today's Tear Prevention and Treatment Handbook. I was tremendously empowered to know of so many views and approaches! Some of the ideas in that booklet are what have helped me feel much more healed, even though I did them many years after the birth trauma. Have a Wonderful and Healing birth!

— Beth Barbeau, Midwife
Ann Arbor, Michigan

A: Take heart, there is no easy answer here. I am a new doula who did home delivery of my two babies. At the first birth, only her father and I were present. He caught her mid air—no support for my perineum. You can bet that the second time I waited for the midwife's hands. I couldn't believe the difference in my post partum healing.

Yes, my yoni is forever changed—I often say I went from a tulip to an orchid. Have you ever seen the artwork of Judy Chicago?

I hope you have the assistance you need, loving attention, discussing your fears before the birth. What about waterbirth?

I understand that the outcome for this issue varies. Excellent nutrition and faith in your body can only help.

I did go to hospital after the birth for a "touch up." This felt like cosmetic surgery but was a simple cut of a tag that had caused me pain during intercourse between babes. I was disappointed that none of my momma friends warned me about the pain of healing my perineum after the birth. Maybe this should have been obvious, but I was in shock.

You can stretch enough not to tear. You are strong enough to heal no matter what. Please keep talking about your concerns.

— Kristin
Iowa

A: I feel like I'm reading my own story when I read your concerns about the perineal tear you experienced with delivery of your first child and your fears about the delivery of your next child.

I experienced a second degree tear with the delivery of my first child that healed "horribly"—I was unable to have intercourse for approximately a year following delivery (despite "healing nicely" according to the midwives) and continued to experience pain using internal menstrual products, having intercourse, etc., until two and a half years after the birth of my first child—until I delivered my second child.

With my second child I experienced even more extensive tearing and was transferred to hospital after his birth so an obstetrician could spend 45 minutes (under spinal anesthetic) repairing the third degree tear that was well out of the realm of my midwife's capabilities. I truly believe that there was no way for my second baby to pass through me into my arms with out "tearing" through. I knew/know that a baby's head could not move through a passage (without causing trauma) that had been stitched up too tightly to have intercourse without pain.

The recovery from a third degree tear was uncomfortable, to say the least (as you are well aware from your own experience). But I am so relieved that I experienced a tear with my second child that needed such expert repair—the obstetrician did a beautiful job and I truly "healed beautifully" this time. Yes, it took time (longer than the six weeks many suggested) to feel the absence of pain and then a little longer to feel the absence of tightness or even sensitivity, but my youngest just turned two and I now feel as normal as the days before I birthed either of my dear children.

So yes, you can "heal better" from a more expertly repaired tear following a poorly repaired tear. If indeed you must tear to permit the passage of your newest baby into your arms, then I truly hope that your are stitched by expert, careful and caring hands that may be able to restore for you the confidence that your perineum is "normal" and "healed" again. If that person is a caregiver other than the one who attends you during your birth, then so be it. You need not feel "broken" even after healing from a third degree tear.

— Anonymous
Edmonton, Alberta, Canada

A: I fully understand and feel your particular pain. I, too, suffered a third degree tear as well as an episiotomy that I did not agree to. I subsequently gave birth to my second child vaginally, while lying on my side so as to put minimal pressure on my perineum, and tore only a little bit. It did not require any stitching AND was toward the top of my labia, not anywhere near my perineum. Baby #2 was quite a bit bigger than #1 as well.

My point is that you can still have a beautiful, trauma-free experience this time around. I don't know how much you have done to try to nurture those tissues but it's not too late to use herbal compresses (with things like yarrow and comfrey) and do some perineal massage with oils of your own to prepare those tissues. I think for me the biggest problem I had was the fear of tearing it all over again and never being the same. Maybe the psychological part of it is the biggest part of healing for you too? With proper support, I'm sure things will be fine for you this time. My advice is to talk with your care provider about your feelings and your fears letting them know that this time around you really want extra support when it's time to push. Try to push in positions that are not stressful to your perineum as well. (For example, no squatting without lots of extra support.) Best of luck to you!

— Jodi G.R.

Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.

Think about It

The National Center for Health Statistics (NCHS) recently released preliminary birth data for 2005. Several alarming trends were noted: an increase in the cesarean rate to 30.2%—the highest rate ever reported; and an increase in late preterm births to 9.1%. Susan Hodges, of Citizens for Midwifery, points out in her Grassroots Network E-News that [w]hile the report does not mention any connection, it is probable that planned cesareans and early inductions contribute to this kind of prematurity.

All questions and comments submitted to Midwifery Today E-News become the property of Midwifery Today, Inc. They may be used either in full or as an excerpt, and will be archived on the Midwifery Today Web site.

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Through networking and education, Midwifery Today's mission is to return midwifery care to its rightful position in the family, to make midwifery care the norm throughout the world, and to redefine midwifery as a vital partnership with women.